title: Vancomycin trough concentrations in overweight or obese pediatric patients.
abstract: OBJECTIVE
  To compare vancomycin trough concentrations in overweight or obese pediatric patients to those with normal body habitus, after initial dosing based on total body weight (TBW).
  
  
  METHODS
  Retrospective observational case-control study.
  
  
  METHODS
  Free-standing academic pediatric hospital.
  
  
  METHODS
  Forty-two overweight or obese pediatric patients were matched to 84 children of normal body habitus (NBH).
  
  
  RESULTS
  Empiric vancomycin dosing was based on TBW and guided by an age-stratified dosing algorithm previously developed at our center. Initial steady-state vancomycin trough concentrations were retrieved from the electronic medical record. Overweight and obese children had significantly higher initial vancomycin trough concentrations compared with children who had an NBH (median 14.4 μg/ml vs 10.5 μg/ml, p<0.001). Initial vancomycin trough concentrations above 20 μg/ml occurred more often in overweight and obese children (p=0.016). Our dosing algorithm suggested that initial vancomycin trough concentrations below 10 μg/ml occurred significantly more often in children with NBH (p<0.001).
  
  
  CONCLUSIONS
  Overweight and obese pediatric patients may have elevated initial vancomycin trough concentrations when empiric dosing is based on TBW. Special attention to therapeutic drug monitoring is warranted in all children.
authors.affiliation: Department of Pharmacy, Children's Mercy Hospitals and Clinics, Kansas City, Missouri.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Heble
authors.forename: Christopher
authors.initials: C
authors.lastname: McPherson
authors.forename: Miranda P
authors.initials: MP
authors.lastname: Nelson
authors.forename: David A
authors.initials: DA
authors.lastname: Hunstad
mesh_terms: D000293:Adolescent; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D001835:Body Weight; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications*; D050177:Overweight / Q000150:complications*; D012189:Retrospective Studies; D014640:Vancomycin / Q000008:administration & dosage / Q000493:pharmacokinetics*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: obese; overweight; pediatrics; therapeutic drug monitoring; vancomycin